A nurse is caring for four clients. Which of the following clients is at the greatest risk for falling?

A client who has diminished vision ambulating in well-lit areas

A client who received a diuretic 30 min ago

A client who requires assistance with ambulation

A client who had a tonic-clonic seizure 2 hr ago

Answer and Explanation

The Correct Answer is D

A.   A client with diminished vision ambulating in well-lit areas may be at risk for falling but is not at the greatest risk among the options provided.
B.   A client who received a diuretic 30 min ago may experience orthostatic hypotension, which can increase the risk of falling, but it is not the highest risk.
C.   A client who requires assistance with ambulation is generally at a lower risk than a client who has recently experienced a tonic-clonic seizure.
D.   A client who had a tonic-clonic seizure 2 hr ago is at the greatest risk for falling due to potential residual weakness, disorientation, or postictal state following the seizure.

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Correct Answer is C

Explanation

A. Controlled substances typically require a licensed nurse or provider to witness the wasting, not assistive personnel.
B. Wasted medication should be disposed of according to facility policies but not necessarily in a sharps container unless it is a sharp object.
C. Recording the amount of medication wasted on the controlled substance inventory record is a crucial step to maintain accurate documentation.
D. Returning the unused portion of a controlled substance to the pharmacy is not an appropriate action and goes against medication safety protocols. Controlled substances should be wasted and documented properly.

A. Clients from most cultures will be receptive to a scientific perspective. B. Assigning clients to specific cultural categories facilitates communication. C. Disease and illness are not necessarily influenced by culture. D. The meaning of behavior can vary widely across cultures.

Correct Answer is D

Explanation

A. While some clients may be receptive to a scientific perspective, cultural beliefs and practices can significantly influence health-related decisions and behaviors.
B. Assigning clients to specific cultural categories can lead to stereotyping and may not account for the individual variations within a cultural group.
C. Disease and illness can indeed be influenced by cultural factors, including beliefs about health and healing practices.

D. The meaning of behavior can vary widely across cultures, and understanding the cultural context is crucial for providing culturally competent care.

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A nurse is caring for four clients. Which of the following clients is at the greatest risk for falling?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse in a hospital setting is preparing to administer a partial dose of a prefilled opioid analgesic parenterally. Which of the following is an appropriate action by the nurse?

Correct Answer is C

Explanation

To plan culturally competent care, a nurse should consider that:

Correct Answer is D

Explanation

A nurse is preparing to insert an NG tube for a client who requires enteral feedings. Which of the following instructions should the nurse give the client before beginning the procedure?

A nurse is caring for a client who has been diagnosed with breast cancer. After months of treatment, the client refuses to undergo further radiation therapy. Which of the following actions by the nurse is appropriate?

A 5-year-old client is refusing to let the nurse take his blood pressure. To promote cooperation, the nurse should:

A nurse is caring for a client who requires a peripheral IV insertion. When choosing the site, which of the following is an appropriate action for the nurse to take?

A charge nurse is verifying a client's prescription which another nurse transcribed from a telephone order. Which of the following orders should the nurse recognize as including unaccepted abbreviations when documenting care?

A nurse is preparing to administer dextrose 5% in 0.45% sodium chloride 1,200 mL IV to infuse over 8 hr. The nurse should set the IV pump to deliver how many mL/hr? (Round the answer to the nearest whole number. Use a leading zero is applicable. Do not use a trailing zero.)

A nurse is caring for a client who has a dysrhythmia. Which of the following techniques is appropriate for the nurse to use to assess for a pulse deficit?

A nurse observes an assistive personnel (AP) empty an indwelling urinary catheter drainage bag while not wearing gloves. Which of the following interventions should the nurse take first?